Differential Diagnosis for Transient Vertigo

The patient's symptoms of short-lasting vertigo, an earthquake-like feeling, sensation of falling, all lasting for 3-5 seconds, with normal MRI brain and spine, suggest a variety of potential diagnoses. These can be categorized as follows:

• Single Most Likely Diagnosis

  • Benign Paroxysmal Positional Vertigo (BPPV): This condition is characterized by brief, intense episodes of vertigo triggered by specific head movements, lasting a few seconds. The symptoms described, such as the earthquake-like feeling and sensation of falling, are consistent with BPPV, especially given the short duration of the episodes.

• Other Likely Diagnoses

  • Vestibular Migraine: Although typically associated with headache, vestibular migraines can cause vertigo without headache. The brief episodes could fit this diagnosis, especially if the patient has a history of migraines.
  • Meniere's Disease: Characterized by episodes of vertigo, hearing loss, tinnitus, and ear fullness. Early stages might present with vertigo alone, but the episodes usually last longer than those described.
  • Labyrinthitis: Inflammation of the inner ear, which can cause vertigo. However, it often presents with hearing loss and the episodes may last longer.

• Do Not Miss Diagnoses

  • Transient Ischemic Attack (TIA) or Stroke: Although less likely given the brief and recurrent nature of the symptoms, it's crucial to consider vascular causes, especially if there are risk factors for stroke. The normal MRI does not entirely rule out a vascular event, particularly if it was very recent or small.
  • Multiple Sclerosis: Can present with vertigo among other neurological symptoms. The normal MRI reduces the likelihood but does not rule it out entirely, as lesions might not always be visible, especially early in the disease.

• Rare Diagnoses

  • Perilymph Fistula: A condition where there's an abnormal connection between the inner and middle ear, leading to vertigo and hearing loss. Symptoms can be triggered by changes in pressure.
  • Superior Canal Dehiscence: A rare condition where there's an abnormal opening in the bone overlying the superior canal, leading to vertigo and hearing symptoms in response to sound or pressure changes.
  • Episodic Ataxia: A group of rare conditions characterized by episodes of ataxia, which can include vertigo. These are often genetic and may be associated with other neurological symptoms.

Each of these diagnoses has a different set of implications for treatment and prognosis, highlighting the importance of a thorough evaluation to determine the underlying cause of the patient's symptoms.